Health Communications

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VanServellen_PP_Ch16.ppt

Communication

Skills

for the

Health Care

Professional

Concepts, Practice, and Evidence

Gwen van Servellen

CHAPTER 16

© 2009 Jones and Bartlett Publishers

Chapter 16
Communicating Effectively with Patients Displaying Significant Negative or Resistive Coping Responses

© 2009 Jones and Bartlett Publishers

Objectives

  • Multidimensional situations: patients, tasks, and care contexts
  • Types of difficult patient behaviors and underlying communications
  • Ways provider can monitor and apply specific guidelines
  • Difficult patient encounters and corresponding therapeutic responses

© 2009 Jones and Bartlett Publishers

Difficult Patients, Tasks, and Care Contexts

  • Difficult patients: behaviors evoke distress in the provider exceeding that expected or accepted
  • Up to 15% of provider-patient encounters are “difficult”
  • 10%-20% of consultations are with patients of this type

© 2009 Jones and Bartlett Publishers

Difficult Patients, Tasks, and Care Contexts Continued

  • Care contexts, e.g. dying patient, newly diagnosed terminally ill patient
  • Care situations, e.g. poorly staffed, little patient continuity, lack of transfer of important medical data

© 2009 Jones and Bartlett Publishers

Difficult Behaviors

  • Dependent or manipulative
  • Aggressive
  • Condescending
  • Self-pitying
  • Complaining
  • Demanding

© 2009 Jones and Bartlett Publishers

Behaviors and Underlying Meanings

  • The non-adherent patient
  • Patient barriers
  • Treatment and disease burden
  • Patient-provider relationship and system barriers

© 2009 Jones and Bartlett Publishers

Manipulative-Dependent

  • Found among all genders, ages, ethnicities, income classes
  • Exaggerated expressions of powerlessness and hopelessness and may be fabricated
  • Reinforces the authority-subordinate relationship between provider and patient

© 2009 Jones and Bartlett Publishers

Responses to Manipulative Dependent Patient

  • Thorough assessment of behaviors
  • Set limits on demands and requests, especially if fabricated
  • Establish the goals of treatment and engage patient actively as a partner
  • Avoid honoring special privileges or patient bargaining
  • Avoid accepting flattery

© 2009 Jones and Bartlett Publishers

Aggressive Patient

  • Expressed aggression toward provider is troublesome and can occur for many reasons
  • Patient may or may not be aware of underlying hostility
  • Assault is rare but can occur

© 2009 Jones and Bartlett Publishers

Responses to Aggression

  • Fully assess the foundations for the aggression, including health status
  • Lower the stimuli in the immediate environment
  • Avoid direct contact if possible or approach with a colleague
  • Evaluate for medication needs, e.g. pain medications and mild sedative

© 2009 Jones and Bartlett Publishers

Discuss Underlying Meanings and Therapeutic Responses

  • Complaining and demanding patient
  • Patient in denial of illness or prognosis
  • Depressed or anxious patient

© 2009 Jones and Bartlett Publishers

Monitoring Own Reactions

  • Become aware of your reactions and reflect
  • Enhance awareness and observation skills
  • Show patient respect
  • Practice unconditional positive regard
  • Show concern and interest
  • Practice objectivity
  • Conduct analyses with input from colleagues

© 2009 Jones and Bartlett Publishers

Summary

Dealing with difficult patients, difficult tasks, and difficult care contexts is omnipresent in health care. Providers’ abilities rely on awareness, observation, and well placed responses.

© 2009 Jones and Bartlett Publishers